Provider Demographics
NPI:1124682935
Name:MAT L.L.C.
Entity type:Organization
Organization Name:MAT L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MILADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAGOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-585-8523
Mailing Address - Street 1:624 EISENHOWER ST
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830-9707
Mailing Address - Country:US
Mailing Address - Phone:606-585-8523
Mailing Address - Fax:
Practice Address - Street 1:624 EISENHOWER ST
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-9707
Practice Address - Country:US
Practice Address - Phone:606-585-8523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No174200000XOther Service ProvidersMeals
No251E00000XAgenciesHome Health
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No293D00000XLaboratoriesPhysiological Laboratory
No305S00000XManaged Care OrganizationsPoint of Service
No331L00000XSuppliersBlood Bank
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335G00000XSuppliersMedical Foods Supplier
No347E00000XTransportation ServicesTransportation Broker